المؤلفون: Shekelle, Paul, Miake-Lye, Isomi, Begashaw, Meron, Booth, Marika, Myers, Bethany, Lowery, Nicole, Shrank, William

المصدر: Journal of General Internal Medicine. 39(6)

مصطلحات موضوعية: loneliness, meta-analysis, social determinants of health, Humans, Loneliness, Aged, Independent Living, Social Support, Social Isolation

الوصف: BACKGROUND: The problem of loneliness has garnered increased attention from policymakers, payors, and providers due to higher rates during the pandemic, particularly among seniors. Prior systematic reviews have in general not been able to reach conclusions about effectiveness of interventions. METHODS: Computerized databases were searched using broad terms such as loneliness or lonely or social isolation or social support from Jan 1, 2011 to June 23, 2021. We reference mined existing systematic reviews for additional and older studies. The Social Interventions Research & Evaluation Network database and Google were searched for gray literature on Feb 4, 2022. Eligible studies were RCTs and observational studies of interventions to reduce loneliness in community-living adults that used a validated loneliness scale; studies from low- or middle-income countries were excluded, and studies were excluded if restricted to populations where all persons had the same disease (such as loneliness in persons with dementia). RESULTS: A total of 5971 titles were reviewed and 60 studies were included in the analysis, 36 RCTs and 24 observational studies. Eleven RCTs and 5 observational studies provided moderate certainty evidence that group-based treatment was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.27, 95% CI - 0.48, - 0.08). Five RCTs and 5 observational studies provided moderate certainty evidence that internet training was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.22, 95% CI - 0.30, - 0.14). Low certainty evidence suggested that group exercises may be associated with very small reductions in loneliness. Evidence was insufficient to reach conclusions about group-based activities, individual in-person interactions, internet-delivered interventions, and telephone-delivered interventions. DISCUSSION: Low-to-moderate certainty evidence exists that group-based treatments, internet training, and possibly group exercises are associated with modest reductions in loneliness in community-living older adults. These findings can inform the design of supplemental benefits and the implementation of evidence-based interventions to address loneliness. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO ( CRD42021272305 ).

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0s432023Test
https://escholarship.org/content/qt0s432023/qt0s432023.pdfTest

المؤلفون: Weitzner, Zachary, Phan, Jennifer, Begashaw, Meron, Mak, Selene, Booth, Marika, Shekelle, Paul, Maggard-Gibbons, Melinda, Girgis, Mark

المصدر: Surgical Endoscopy. 37(11)

مصطلحات موضوعية: AspireAssist, Bariatric endoscopy, Endoscopic sleeve gastrectomy, Intragastric balloon, Humans, Quality of Life, Treatment Outcome, Obesity, Endoscopy, Gastroplasty, Weight Loss, Obesity, Morbid

الوصف: BACKGROUND: Obesity is a major threat to public health and traditional bariatric surgery continues to have low utilization. Endoscopic treatments for obesity have emerged that offer less risk, but questions remain regarding efficacy, durability, and safety. We compared the efficacy of endoscopic bariatric procedures as compared to other existing treatments. METHODS: A literature search of Embase, Cochrane Central, and Pubmed was conducted from January 1, 2014 to December 7, 2021, including endoscopic bariatric therapies that were FDA or CE approved at the time of search to non-endoscopic treatments. Thirty-seven studies involving 15,639 patients were included. Primary outcomes included % total body weight loss (%TBWL), % excess body weight loss (%EBWL), and adverse events. Secondary outcomes included quality of life data and differences in hemoglobin A1C levels. Strength of clinical trial and observational data were graded according to the Cochrane methods. RESULTS: Intragastric balloons achieved greater %TBWL with a range of 7.6-14.1% compared to 3.3-6.7% with lifestyle modification at 6 months, and 7.5-14.0% compared to 3.1-7.9%, respectively, at 12 months. When endoscopic sleeve gastroplasty (ESG) was compared to laparoscopic sleeve gastrectomy (LSG), ESG had less %TBWL at 4.7-14.4% compared to 18.8-26.5% after LSG at 6 months, and 4.5-18.6% as compared to 28.4-29.3%, respectively, at 12 months. For the AspireAssist, there was greater %TBWL with aspiration therapy compared to lifestyle modification at 12 months, 12.1-18.3% TBWL versus 3.5-5.9% TBWL, respectively. All endoscopic interventions had higher adverse events rates compared to lifestyle modification. CONCLUSION: This review is the first to evaluate various endoscopic bariatric therapies using only RCTs and observational studies for evaluation of weight loss compared with conservative management, lifestyle modification, and bariatric surgery. Endoscopic therapies result in greater weight loss compared to lifestyle modification, but not as much as bariatric surgery. Endoscopic therapies may be beneficial as an alternative to bariatric surgery.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/30j3b5c7Test

المؤلفون: Blegen, Mariah, Corley, Alyssa, Ulloa, Jesus, Booth, Marika, Begashaw, Meron, Larkin, Jody, Shekelle, Paul, Girgis, Mark, Maggard-Gibbons, Melinda, Premji, Alykhan

المصدر: Systematic Reviews. 12(1)

مصطلحات موضوعية: DAPT, Perioperative Management, Surgery

الوصف: BACKGROUND: Antiplatelet agents are central in the management of vascular disease. The use of dual antiplatelet therapy (DAPT) for the management of thromboembolic complications must be weighed against bleeding risk in the perioperative setting. This balance is critical in patients undergoing cardiac or non-cardiac surgery. The management of patients on DAPT for any indication (including stents) is not clear and there is limited evidence to guide decision-making. This review summarizes current evidence since 2015 regarding the occurrence of major adverse events associated with continuing, suspending, or varying DAPT in the perioperative period. METHODS: A research librarian searched PubMed and Cochrane from November 30, 2015 to May 17, 2022, for relevant terms regarding adult patients on DAPT for any reason undergoing surgery, with a perioperative variation in DAPT strategy. Outcomes of interest included the occurrence of major adverse cardiac events, major adverse limb events, all-cause death, major bleeding, and reoperation. We considered withdrawal or discontinuation of DAPT as stopping either aspirin or a P2Y12 inhibitor or both agents; continuation of DAPT indicates that both drugs were given in the specified timeframe. RESULTS: Eighteen observational studies met the inclusion criteria. No RCTs were identified, and no studies were judged to be at low risk of bias. Twelve studies reported on CABG. Withholding DAPT therapy for more than 2 days was associated with less blood loss and a slight trend favoring less transfusion and surgical re-exploration. Among five observational CABG studies, there were no statistically significant differences in patient death across DAPT management strategies. Few studies reported cardiac outcomes. The remaining studies, which were about procedures other than exclusively CABG, demonstrated mixed findings with respect to DAPT strategy, bleeding, and ischemic outcomes. CONCLUSION: The evidence base on the benefits and risks of different perioperative DAPT strategies for patients with stents is extremely limited. The strongest signal, which was still judged as low certainty evidence, is that suspension of DAPT for greater than 2 days prior to CABG surgery is associated with less bleeding, transfusions, and re-explorations. Different DAPT strategies association with other outcomes of interest, such as MACE, remains uncertain. SYSTEMATIC REVIEW REGISTRATION: A preregistered protocol for this review can be found on the PROSPERO International Prospective Register of systematic reviews ( http://www.crd.york.ac.uk/PROSPEROTest/ ; registration number: CRD42022371032).

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/7pt5p8nwTest

المؤلفون: Blegen, Mariah, Ko, Jamie, Salzman, Garrett, Begashaw, Meron M, Ulloa, Jesus G, Girgis, Mark, Shekelle, Paul, Maggard-Gibbons, Melinda

المصدر: Journal of the American College of Surgeons. 237(2)

مصطلحات موضوعية: Humans, United States Department of Veterans Affairs, Hospitals, Veterans, Health Services Accessibility, United States, Patient Safety, Clinical Research, Clinical Trials and Supportive Activities, Comparative Effectiveness Research, Health Services, Health and social care services research, 8.1 Organisation and delivery of services, Generic health relevance, Good Health and Well Being, Clinical Sciences, Surgery

الوصف: In response to concerns about healthcare access and long wait times within the Veterans Health Administration (VA), Congress passed the Choice Act of 2014 and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 to create a program for patients to receive care in non-VA sites of care, paid by VA. Questions remain about the quality of surgical care between these sites in specific and between VA and non-VA care in general. This review synthesizes recent evidence comparing surgical care between VA and non-VA delivered care across the domains of quality and safety, access, patient experience, and comparative cost/efficiency (2015 to 2021). Eighteen studies met the inclusion criteria. Of 13 studies reporting quality and safety outcomes, 11 reported that quality and safety of VA surgical care were as good as or better than non-VA sites of care. Six studies of access did not have a preponderance of evidence favoring care in either setting. One study of patient experience reported VA care as about equal to non-VA care. All 4 studies of cost/efficiency outcomes favored non-VA care. Based on limited data, these findings suggest that expanding eligibility for veterans to get care in the community may not provide benefits in terms of increasing access to surgical procedures, will not result in better quality, and may result in worse quality of care, but may reduce inpatient length of stay and perhaps cost less.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5mf9g2g1Test

المؤلفون: Calonge, N (ORCID 0000-0002-2653-6001), Shekelle, Paul G., Owens, Douglas K., Teutsch, Steven, Downey, Autumn, Brown, Lisa, Noyes, Jane (ORCID 0000-0003-4238-5984)

المصدر: Research Synthesis Methods. Jan 2023 14(1):36-51.

تمت مراجعته من قبل الزملاء: Y

Page Count: 16

Sponsoring Agency: Centers for Disease Control and Prevention (CDC) (DHHS/PHS)

الواصفات: Evidence, Synthesis, Mixed Methods Research, Public Health, Emergency Programs, Intervention, Evidence Based Practice, Grading, Evaluation Methods

مستخلص: Despite research investment and a growing body of diverse evidence there has been no comprehensive review and grading of evidence for public health emergency preparedness and response practices comparable to those in medicine and other public health fields. The National Academies of Sciences, Engineering, and Medicine convened an ad hoc committee to develop and use methods for grading and synthesizing diverse types of evidence to create a single certainty of intervention-related evidence to support recommendations for Public Health Emergency Preparedness and Response Research. A 13-step consensus building method was used. Experts were first canvassed in public meetings, and a comprehensive review of existing methods was undertaken. Although aspects of existing review methodologies and evidence grading systems were relevant, none adequately covered all requirements for this specific context. Starting with a desire to synthesize diverse sources of evidence not usually included in systematic reviews and using GRADE for assessing certainty and confidence in quantitative and qualitative evidence as the foundation, we developed a mixed-methods synthesis review and grading methodology that drew on (and in some cases adapted) those elements of existing frameworks and methods that were most applicable. Four topics were selected as test cases. The process was operationalized with a suite of method-specific reviews of diverse evidence types for each topic. Further consensus building was undertaken through stakeholder engagement and feedback The NASEM committee's GRADE adaption for mixed-methods reviews will further evolve over time and has yet to be endorsed by the GRADE working group.

Abstractor: As Provided

المؤلفون: McCleskey, Sara, Shek, Lili, Grein, Jonathan, Gotanda, Hiroshi, Anderson, Laura, Shekelle, Paul, Keeler, Emmett, Morton, Sally, Nuckols, Teryl

المصدر: BMJ Quality and Safety. 31(4)

مصطلحات موضوعية: cost-effectiveness, nosocomial infections, quality improvement, Catheters, Cost-Benefit Analysis, Female, Hospitals, Humans, Male, Quality Improvement, Urinary Tract Infections

الوصف: BACKGROUND: Hospitals have implemented diverse quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). The economic value of these QI interventions is uncertain. OBJECTIVE: To systematically review economic evaluations of QI interventions designed to prevent CAUTI in acute care hospitals. METHODS: A search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicines Grey Literature Report, WorldCat, IDWeek conference abstracts and prior systematic reviews was conducted from January 2000 to October 2020.We included English-language studies of any design that evaluated organisational or structural changes to prevent CAUTI in acute care hospitals, and reported programme and infection-related costs.Dual reviewers assessed study design, effectiveness, costs and study quality. For each eligible study, we performed a cost-consequences analysis from the hospital perspective, estimating the incidence rate ratio (IRR) and incremental net cost/savings per hospital over 3 years. Unadjusted weighted regression analyses tested predictors of these measures, weighted by catheter days per study. RESULTS: Fifteen unique economic evaluations were eligible, encompassing 74 hospitals. Across 12 studies amenable to standardisation, QI interventions were associated with a 43% decline in infections (mean IRR 0.57, 95% CI 0.44 to 0.70) and wide ranges of net costs (mean US$52 000, 95% CI -$288 000 to $392 000), relative to usual care. CONCLUSIONS: QI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9n96j8wbTest

المؤلفون: Miake-Lye, Isomi, Begashaw, Meron, Booth, Marika, Myers, Bethany, Lowery, Nicole, Shrank, William, Shekelle, Paul

المصدر: Journal of General Internal Medicine, vol 39, iss 6

مصطلحات موضوعية: loneliness, meta-analysis, social determinants of health, Humans, Aged, Independent Living, Social Support, Social Isolation

الوصف: BACKGROUND: The problem of loneliness has garnered increased attention from policymakers, payors, and providers due to higher rates during the pandemic, particularly among seniors. Prior systematic reviews have in general not been able to reach conclusions about effectiveness of interventions. METHODS: Computerized databases were searched using broad terms such as loneliness or lonely or social isolation or social support from Jan 1, 2011 to June 23, 2021. We reference mined existing systematic reviews for additional and older studies. The Social Interventions Research & Evaluation Network database and Google were searched for gray literature on Feb 4, 2022. Eligible studies were RCTs and observational studies of interventions to reduce loneliness in community-living adults that used a validated loneliness scale; studies from low- or middle-income countries were excluded, and studies were excluded if restricted to populations where all persons had the same disease (such as loneliness in persons with dementia). RESULTS: A total of 5971 titles were reviewed and 60 studies were included in the analysis, 36 RCTs and 24 observational studies. Eleven RCTs and 5 observational studies provided moderate certainty evidence that group-based treatment was associated with reduced loneliness (standardized mean difference for RCTs = - 0.27, 95% CI - 0.48, - 0.08). Five RCTs and 5 observational studies provided moderate certainty evidence that internet training was associated with reduced loneliness (standardized mean difference for RCTs = - 0.22, 95% CI - 0.30, - 0.14). Low certainty evidence suggested that group exercises may be associated with very small reductions in loneliness. Evidence was insufficient to reach conclusions about group-based activities, individual in-person interactions, internet-delivered interventions, and telephone-delivered interventions. DISCUSSION: Low-to-moderate certainty evidence exists that group-based treatments, internet training, and possibly group exercises are associated with modest ...

وصف الملف: application/pdf

العلاقة: qt0s432023; https://escholarship.org/uc/item/0s432023Test

الإتاحة: https://escholarship.org/uc/item/0s432023Test

المؤلفون: Ly, Dan P, Shekelle, Paul G

المصدر: Journal of the American Geriatrics Society. 70(1)

مصطلحات موضوعية: Health Services and Systems, Biomedical and Clinical Sciences, Health Sciences, Hematology, Clinical Research, Brain Disorders, Prevention, Neurodegenerative, Patient Safety, Cardiovascular, Rare Diseases, Dementia, Lung, Acquired Cognitive Impairment, 7.3 Management and decision making, Management of diseases and conditions, Neurological, Aged, Aged, 80 and over, Cross-Sectional Studies, Dyspnea, Emergency Service, Hospital, Female, Hospitals, Veterans, Humans, Male, Middle Aged, Practice Patterns, Physicians', Pulmonary Embolism, dementia, physician behavior, physician decision-making, Medical and Health Sciences, Geriatrics, Biomedical and clinical sciences, Health sciences, Psychology

الوصف: BackgroundWhether the presence of dementia in patients makes it difficult for physicians to assess the risk such patients might have for serious conditions such as pulmonary embolism (PE) is unknown. Our objective was to examine the differential association of four clinical factors (deep venous thrombosis (DVT)/PE, malignancy, recent surgery, and tachycardia) with PE testing for patients with dementia compared to patients without dementia.MethodsWe performed a cross-sectional study of emergency department (ED) visits to 104 Veterans Affairs (VA) hospitals from 2011 to 2018 by patients aged 60 years and over presenting with shortness of breath (SOB). Our outcomes were PE testing (CT scan and/or D-dimer) and subsequently diagnosed acute PE.ResultsThe sample included 593,001 patient visits for SOB across 7124 ED physicians; 5.6% of the sample had dementia, and 10.6% received PE testing. Three of the four clinical factors examined had a lower association with PE testing for patients with dementia. For example, after taking into account that at baseline, physicians were 0.9 percentage points less likely to test patients with dementia than patients without dementia for PE, physicians were an additional 2.6 percentage points less likely to test patients with dementia who had tachycardia than patients without dementia who had tachycardia. We failed to find evidence that any clinical factor examined had a differentially lower association with a subsequently diagnosed acute PE for patients with dementia.ConclusionsClinical factors known to be predictive of PE risk had a lower association with PE testing for patients with dementia compared to patients without dementia. These results may be consistent with physicians missing these clinical factors more often when evaluating patients with dementia, but also with physicians recognizing such factors but not using them in the decision-making process. Further understanding how physicians evaluate patients with dementia presenting with common acute symptoms may help improve the care delivered to such patients.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3fb3169fTest

المؤلفون: Ye, Linda, Childers, Christopher P, de Virgilio, Michael, Shenoy, Rivfka, Mederos, Michael A, Mak, Selene S, Begashaw, Meron M, Booth, Marika S, Shekelle, Paul G, Wilson, Mark, Gunnar, William, Girgis, Mark D, Maggard-Gibbons, Melinda

المصدر: BJS Open. 5(6)

مصطلحات موضوعية: Comparative Effectiveness Research, Digestive Diseases, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Hernia, Ventral, Herniorrhaphy, Humans, Incisional Hernia, Robotic Surgical Procedures, Robotics

الوصف: Robotic ventral hernia repair (VHR) has seen rapid adoption, but with limited data assessing clinical outcome or cost. This systematic review compared robotic VHR with laparoscopic and open approaches. This systematic review was undertaken in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Cochrane databases were searched for articles with terms relating to 'robot-assisted', 'cost effectiveness', and 'ventral hernia' or 'incisional hernia' from 1 January 2010 to 10 November 2020. Intraoperative and postoperative outcomes, pain, recurrence, and cost data were extracted for narrative analysis. Of 25 studies that met the inclusion criteria, three were RCTs and 22 observational studies. Robotic VHR was associated with a longer duration of operation than open and laparoscopic repairs, but with fewer transfusions, shorter hospital stay, and lower complication rates than open repair. Robotic VHR was more expensive than laparoscopic repair, but not significantly different from open surgery in terms of cost. There were no significant differences in rates of intraoperative complication, conversion to open surgery, surgical-site infection, readmission, mortality, pain, or recurrence between the three approaches. Robotic VHR was associated with a longer duration of operation, fewer transfusions, a shorter hospital stay, and fewer complications compared with open surgery. Robotic VHR had higher costs and a longer operating time than laparoscopic repair. Randomized or matched data with standardized reporting, long-term outcomes, and cost-effectiveness analyses are still required to weigh the clinical benefits against the cost of robotic VHR.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6mg36845Test

المؤلفون: Shenoy, Rivfka, Mederos, Michael A, Ye, Linda, Mak, Selene S, Begashaw, Meron M, Booth, Marika S, Shekelle, Paul G, Wilson, Mark, Gunnar, William, Maggard-Gibbons, Melinda, Girgis, Mark D

المصدر: Systematic reviews. 10(1)

مصطلحات موضوعية: Humans, Gallbladder Diseases, Laparoscopy, Length of Stay, Cholecystectomy, Cholecystectomy, Laparoscopic, Robotics, Gallbladder, Laparoscopic, Review, Robot-assisted, Clinical Trials and Supportive Activities, Clinical Research, Bioengineering, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Medical and Health Sciences

الوصف: BackgroundRapid adoption of robotic-assisted general surgery procedures, particularly for cholecystectomy, continues while questions remain about its benefits and utility. The objective of this study was to compare the clinical effectiveness of robot-assisted cholecystectomy for benign gallbladder disease as compared with the laparoscopic approach.MethodsA literature search was performed from January 2010 to March 2020, and a narrative analysis was performed as studies were heterogeneous.ResultsOf 887 articles screened, 44 met the inclusion criteria (range 20-735,537 patients). Four were randomized controlled trials, and four used propensity-matching. There were variable comparisons between operative techniques with only 19 out of 44 studies comparing techniques using the same number of ports. Operating room time was longer for the robot-assisted technique in the majority of studies (range 11-55 min for 22 studies, p < 0.05; 15 studies showed no difference; two studies showed shorter laparoscopic times), while conversion rates and intraoperative complications were not different. No differences were detected for the length of stay, surgical site infection, or readmissions. Across studies comparing single-port robot-assisted to multi-port laparoscopic cholecystectomy, there was a higher rate of incisional hernia; however, no differences were noted when comparing single-port robot-assisted to single-port laparoscopic cholecystectomy.ConclusionsClinical outcomes were similar for benign, elective gallbladder disease for robot-assisted compared with laparoscopic cholecystectomy. Overall, the rates of complications were low. More high-quality studies are needed as the robot-assisted technique expands to more complex gallbladder disease, where its utility may prove increasingly beneficial.Systematic review registrationPROSPERO CRD42020156945.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3rw714w5Test